Faults found at Easton Hospital: State inspection finds missed criminal background checks and other violations

Tim DarraghOF THE MORNING CALL

Easton Hospital could not document that it conducted complete criminal background checks on prospective employees as required by Pennsylvania law and health regulations, a state inspection found.

According to a Department of Health inspection this summer, in each of six personnel files it reviewed of workers hired since July 2008, hospital officials could not provide evidence for at least one of three mandated criminal checks.

The inspection, dated Aug. 15 but only recently made public, also found:

Parents of newborns were not given state-required Sudden Infant Death Syndrome education and prevention materials.

Nearly three dozen failures to document oral orders for medication by a doctor within 24 hours, as required.

Temperatures in an operating room were below the minimum required temperature every day for three months.

Failure to clean a refrigerator used to store breast milk for newborns.

The importance of full background checks at health care institutions came to public attention last year, when records showed that Lehigh Valley Hospital had fired a nurse after learning he had concealed his involuntary manslaughter conviction in another state. Joseph A. Mannino, who was convicted in 1994, studied nursing at St. Luke's Hospital and got a job at LVH until he was fired in 2008. The record of his license revocation became public last year.

The Department of Health did not take action against Easton Hospital for the violations, said spokeswoman Christine Cronkright, saying it submitted a satisfactory plan to correct the deficiencies.

"We will conduct follow-up surveys as necessary to ensure the hospital comes into compliance through the actions that they've identified in the plan of correction," she said.

The inspection was part of the licensing process hospitals in Pennsylvania are required to go through every two years. In response to The Morning Call, Easton Hospital issued a statement saying its priority is to comply with laws and regulations at all times.

"The Aug. 15 inspection identified a need to improve documentation of steps already being taken," it said.

The Health Department frequently inspects hospitals and other health care facilities. Most inspections do not result in violations.

Under state law, the hospital is required to run a prospective employee's name through background checks operated by the Pennsylvania State Police, the Department of Public Welfare's ChildLine and the FBI. The state law applies to employees who "have a significant likelihood of regular contact with children."

In each of the six employee records that were examined, however, the hospital could not show that state police background checks were run. In three of those cases, officials also could not produce evidence that they conducted a DPW ChildLine background check. ChildLine is the department's registry of child abuse cases and is used for child abuse clearances.

In response, the hospital adopted a new process in August to have its director of human resources ensure that all background checks are done. In addition, hospital officials were reviewing the records of all employees hired since the law went into effect in 2008 and said it would complete checks by Sept. 9.

Further, the hospital said it would audit at least 20 employee files for the next four months to ensure compliance, and those reports will be delivered to the board of directors.

The state report did not indicate that any patients were harmed or abused while at the hospital.

During the inspection, investigators also found various departments had supplies in storage that were past their expiration dates -- some by years.

"Facility staff," it said, "failed to rotate and control inventory."

For instance, an oncology department exam room had iodine prep pads that expired in March 2009, a bottle of isopropyl alcohol that expired in August 2010 and a catheterization tray kit that expired in April 1997, it said.

It also said dozens of supplies were out of date in the Level 1 newborn nursery and that the neonatal unit had a pediatric carbon dioxide detector package that expired in June. Additionally, a sterile water package exceeded its expiration date and a protective barrier, which was to remain in place until use, had been removed, it said.

The hospital replied that unit managers are now required to verify that expired products are removed by the fifth day of each month. Failure to comply, the hospital said, will result in disciplinary action. In the statement, the hospital said it also initiated a "double-check process" to verify supply dates before supplies are used for patient care.

In each of five cases surveyed, the hospital also was unable to document that it provided proper SIDS education to parents of newborns. An employee, the report said, "confirmed that the facility did not have a policy" that addressed the state's SIDS parent education requirements.

An employee told inspectors that the hospital did give parents SIDS information, but it was not the state-prescribed record. The hospital said all maternal newborn staff were educated on the new policy and forms by Sept. 1.

Looking at medical records, state investigators also determined that hospital staffers failed to get doctors to sign off on verbal orders within 24 hours, as required by hospital policy. The state identified 14 cases in which records were not countersigned within 24 hours.

Gus Geraci, vice president of physician leadership in quality and value at Pennsylvania Medical Society.

"You don't want to continue an error that was started by miscommunication or some other error," he said.

Beginning Aug. 22, the hospital said verbal orders would not be accepted by the nursing staff except in emergencies. Additionally, doctors were reminded about the hospital policy and Easton's quality department said it would review at least 70 random orders over the next four months to ensure a proper accounting.

Among other things, the state inspection found breast milk being stored in an unclean refrigerator; operating rooms kept below the minimum temperature of 68 degrees; a storage room that had been converted without health inspectors' approval; and a failure of the hospital board of trustees to annually review and update the hospital bylaws.

The report indicated that the problems either were addressed or would be corrected and monitored.

In addition, the hospital said it would document requests to the department to keep operating room temperatures at physicians' preferred levels.